21 / 68
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015
AFRICA
219
significantly decreased in PCOS patients. The total emptying
volume was significantly decreased (17.9
±
5.49 vs 20.67
±
4.29
ml/m
2
,
p
=
0.018) in PCOS patients (Table 3).
Tissue Doppler echocardiography measurements are shown
in Table 3. PAlat [57 (34–87) vs 43 (34–77) ms,
p
<
0.01], PAsep
[48 (42–68) vs 34 (25–67) ms,
p
<
0.01] and PAtri [39 (21–60) vs
28 (22–65) ms,
p
=
0.001] were significantly longer in patients
with PCOS. Interatrial and intra-atrial electromechanical delays
were found to be significantly higher in PCOS patients. Values of
PAlat – PAtri were 19
±
7.4 and 15
±
6.4 ms in PCOS patients and
control subjects, respectively (
p
=
0.035). Median values of PAsep
– PAtri were 8.5 (1–19) and 5 (1–20) ms (
p
=
0.026), respectively.
Age and serum testosterone levels were associated with
interatrial electromechanical delay in the linear regression
analysis (
p
=
0.071,
β
=
0.201 and
p
=
0.052,
β
=
0.242,
respectively). In a multivariate stepwise regression analysis, age
was demonstrated to be an independent predictor of interatrial
electromechanical delay (
p
=
0.013,
β =
–0.321) (Table 4).
Discussion
In the present study, we showed that Pd, and inter- and intra-
atrial conduction times were increased, left atrial mechanical
function was impaired, and transmitral E/A ratio was decreased
in patients with PCOS. To our knowledge, this is the first
Table 1. Clinical and laboratory findings of the study population
PCOS (
n
=
48) Control (
n
=
38)
p
-value
Age (years)
24
±
4
30
±
7
0.001*
BMI (kg/m
2
)
25.4
±
5.4
22.5
±
3.4 0.029*
BSA (m
2
)
1.71
±
0.18
1.64
±
0.13 0.071
Waist/hip ratio
0.80
±
0.05
0.77
±
0.01 0.061
FSH (mIU/ml)
5.07 (2.92–10.1) 7.68 (2.02–19.10) 0.001*
LH (mIU/ml)
6.62 (2.35–39.25) 6.74 (2.03–19.47) 0.442
TSH (μIU /ml)
2.48
±
2.36
1.78
±
0.91 0.110
Estradiol (pg/ml)
43.2
±
17.8
28.8
±
11.3 0.001*
Testosterone (ng/dl)
75.5 (14.7–314)
17.2 (2.5–44) 0.001*
Fasting glucose (mg/dl)
86
±
12
87
±
8
0.945
Total cholesterol (mg/dl)
176
±
34
181
±
38
0.557
HDL (mg/dl)
53
±
15
56
±
14
0.399
LDL (mg/dl)
96
±
28
101
±
33
0.407
TG (mg/dl)
97
±
74
87
±
50
0.880
Fasting insulin (μIU /ml) 15.28
±
23.45
12.74
±
17.57 0.627
HOMA-IR
1.40 (0.37–36.15) 1.44 (0.38–18.99) 0.659
Heart rate (bpm)
82.02
±
13.15
75.24
±
11.02 0.014**
Systolic blood pressure
109
±
7
105
±
8
0.094
Diastolic blood pressure
70
±
6
68
±
8
0.227
P
max
(msn)
97
±
7
102
±
8
0.013*
P
min
(msn)
70
±
6
77
±
7
0.001*
Pd (msn)
27
±
5
24
±
6
0.035*
PCOS
=
polycystic ovary syndrome; BMI
=
body mass index; BSA
=
body surface area; FSH
=
follicular stimulating hormone; LH
=
luteinis-
ing hormone; TSH
=
thyroid stimulating hormone; HDL
=
high-density
lipoprotein; LDL
=
low-density lipoprotein; TG
=
triglycerides; HOMA-
IR
=
homeostasis model assessment of insulin resistance; P
max
=
maxi-
mum P-wave duration; P
min
=
minimum P-wave duration; Pd
=
P-wave
dispersion; *Mann–Whitney
U
-test; **Independent
t-
test.
Table 2. Echocardiographic properties of the study population
PCOS (
n
=
48) Controls (
n
=
38)
p
-value
LVDD (mm)
44.3
±
3.7
43.3
±
3.6
0.222
LVSD (mm)
27.7
±
3.3
26.9
±
4.2
0.330
LVEF (%)
68
±
4
69
±
3
0.433
LA (mm)
33
±
4
32
±
3
0.171
Mitral E wave (cm/s)
91.7
±
15.9
94.4
±
19
0.483
Mitral A wave (cm/s)
59.9
±
12.8
55
±
12.4 0.085
E/A
1.5
±
0.3
1.7
±
0.4
0.023
*
DT (ms)
173
±
16
180
±
19
0.114
Peak S (m/s)
0.09
±
0.01
0.08
±
0.01 0.02
**
LV E
′
(cm/s)
14.5
±
3.5
13.5
±
2.9
0.190
E/E
′
6.5
±
1.6
7.1
±
1.8
0.116
LV IVRT (ms)
112
±
15
109
±
15
0.282
LV IVCT (ms)
371
±
35
373
±
36
0.790
PCOS
=
polycystic ovary syndrome; LV
=
left ventricle; DD
=
diastol-
ic diameter; SD
=
systolic diameter; EF
=
ejection fraction; FS
=
frac-
tional shortening, LA
=
left atrium, DT
=
deceleration time, LV E
′ =
left ventricle early diastolic velocity, IVRT
=
ısovolumetric relaxation
time; IVCT
=
isovolumetric contraction time;
*
Independent
t
-test;
**
Mann–Whitney
U
-test.
Table 3. Atrial conduction times and left atrial
measurements of the study population
PCOS (
n
=
48) Controls (
n
=
38)
p
-value
PA lateral (ms)
57 (34–87)
43 (34–77)
0.001
*
PA septal (ms)
48 (24–68)
34 (25–67)
0.001
*
PA tricuspid (ms)
39 (21–60)
28 (22–65)
0.001
*
PA lateral tricuspid (ms)
19
±
7.4
15.6
±
6.4
0.035
**
PA septal tricuspid (ms)
8.50 (1–19)
5 (1–20)
0.026
*
LA V
max
(ml/m
2
)
24.59
±
6.7
26.31
±
4.95 0.201
LA V
min
(ml/m
2
)
6.11 (2.41–19.23) 5.60 (2.33–11.49) 0.164
LA Vp (ml/m
2
)
11.06 (6.01–29.23) 10.65 (5.23–20.53) 0.398
LA PEV (ml/m
2
)
12.54
±
4.39
15.28
±
3.85 0.004
**
LA PEF (%)
54.4 (21–69)
59.1 (28–74)
0.008
**
LA AEV (ml/m
2
)
5.45
±
2.18
5.39
±
2.12 0.903
LA AEF (%)
45.9
±
10.7
48.7
±
10.5 0.252
LA TEV (ml/m
2
)
17.9
±
5.49
20.67
±
4.29 0.018
**
PA
=
time interval from the onset of P wave to the beginning of the late
myocardial diastolic velocity, LA
=
left atrium; V
max
=
maximum volume;
V
min
=
minimum volume; Vp
=
volume of the beginning atrial systole;
PEV
=
passive emptying volume; PEF
=
passive emptying fraction; AEV
=
active emptying volume; AEF
=
active emptying fraction; TEV
=
total
emptying volume;
*
Mann–Whitney
U
-test;
**
Independent
t
-test.
Table 4. Relation between interatrial conduction delay
and clinical findings. Multivariate analysis model
included age, BMI and testosterone level
Univariate
Multivariate
β
p
β
p
Age
0.201
0.071 –0.321 0.013
BMI
0.031
0.802
Estradiol
0.160
0.160
Insulin
0.047
0.716
HOMA-IR
0.037
0.779
Testosterone
0.242
0.052
E/A ratio
–0.010
0.930
LA passive fraction
–0.063
0.584
Heart rate
0.034
0.761
Total emptying volume 0.020
0.861
LA diameter
0.130
0.247